However, because plague is endemic in Madagascar and the plague season lasts from September to April, more cases of bubonic and sporadic pneumonic plague are expected to be reported until April 2018.

From 1 August to 26 November 2017, a cumulative total of 2,417 confirmed, probable and suspected cases of plague, including 209 deaths (case fatality rate 9%), have been reported from 57 of 114 (50%) districts in Madagascar. Analamanga Region in central Madagascar has been the most affected, with 68% of all recorded cases.

The majority of the reported cases (1,854, 77%) have been clinically classified as pneumonic plague, 355 have been classified as bubonic plague (15%), one was septicemic, and 207 have not yet been classified (further classification of cases is in process).

Since the beginning of this outbreak, the vast majority of cases have been treated and have recovered. As of 26 November 2017, only 13 people were hospitalized for plague. There has been no international spread outside the country.

WHO and other stakeholders will continue to support the Ministry of Health of Madagascar to maintain vigilance and to sustain a strong alert and response system to rapidly detect and respond to new plague cases as they emerge.